Integrity Management Services, Inc. · 3 weeks ago
SIU Analyst/Investigator (Full-time, Remote)
United States
Full-time
Remote
Entry, Mid Level
2+ years expIntegrity Management Services, Inc. is seeking a detail-oriented SIU Analyst/Investigator to join their team. The role involves ensuring accuracy, compliance, and integrity of healthcare claims through audits, analyses, and investigations into fraud, waste, and abuse (FWA). Responsibilities include conducting investigations, developing documentation, performing root cause analyses, and participating in FWA-related education for customers.
Big DataConsultingHuman ResourcesAnalyticsStaffing Agency
Responsibilities
Identify and conduct investigations into known or suspected FWA with high autonomy
Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation
Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e., help move identified case types from "pay-and-chase" to preventive edits and pre-payment activity)
Participate in the development and presentation of FWA-related education for assigned Customers
Perform coding reviews for flagged claims, to support Coding team (if applicable)
Qualification
Required
Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies
Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field
Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
Experience handling confidential information and following policies, rules, and regulations
Experience with commercial, Medicare, or Medicaid claims is highly preferred
Strong analytical and problem-solving skills, with attention to detail and accuracy
Excellent communication skills, both written and verbal, for effective collaboration with internal teams and external providers
Proficiency in Microsoft Office, particularly Excel, and familiarity with claims processing or audit software is a plus
Preferred
Certified Fraud Examiner (CFE)
Accredited Healthcare Fraud Investigator (AHFI)
Certified AML (Anti-Money Laundering) and Fraud Professional (CAFP)
Certified Professional Coder (CPC)
Company
Integrity Management Services, Inc.
Our goal is to empower clients to deliver on their missions, enhance program/payment integrity initiatives, and elevate best practices utilizing decades of experience in healthcare fraud, waste, and abuse (FWA).
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Desia Anne Ritson
President/CEO
Cheryl Gordon
Partner, CFO/CPA
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